Development of Secondary Triage Rules for Interfacility Transfer of Patients with Traumatic Brain Injury

Hong, Won Pyo; Kim, Yu Jin; Shin, Sang Do; Jung, Sung Koo; Suh, Gil Joon; Song, Kyoung Jun

Abstract

PURPOSE
This study was aimed to develop secondary triage rule for decision of interfacility transfer to higher level of trauma center for patients with traumatic brain injury (TBI).
METHODS
In a prospective observational study from August 2006 to December 2007 conducted in an urban tertiary emergency department, data were obtained from patients more than 15 years old and with TBI. Primary outcome was defined as meaningful positive CT findings. Secondary outcome was defined as meaningful intervention. Non-adjusted univariated logistic regression model was derived from result of chi-square test and adjusted model was derived using stepwise selection manner. Hosman-Lemeshow test for the goodness of fit was used.
RESULTS
Total number of eligible patients with traumatic brain injury was 653. Primary outcome was positive in 103 patients and secondary outcome was positive in 42 patients. In univariate logistic regression, risk factors were age over 65(OR: 2.40), history of cerebrovascular disease(OR: 7.08), fall over two meter(OR: 6.28), pedestrian struck(OR: 18.5), headache(OR: 2.18), vomiting(OR: 3.03), disorientation(OR: 5.37), any evidence of open fracture(OR: 24.03), Glasgow coma sacle less than 13(OR: 4.97), Racoon's eye sign (OR: 2.50). These 10 risk factors were statistically significant in adjusted model which was derived using stepwise selected manner. Hosman-Lemeshow test for the goodness of fit was used and chi-square was 1.307(p=0.86). This decision rule had a sensitivity of 93.48%, a specificity of 41.13%, and a negative predictive value of 97.32%.
CONCLUSION
A sensitive clinical decision rule with high negative predictive value for detection of abnormal CT lesions which need transfer to higher level of trauma center was developed.